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Obesity Surgery

, Volume 23, Issue 10, pp 1624–1631 | Cite as

Clinical Impact of a 6-Week Preoperative Very Low Calorie Diet on Body Weight and Liver Size in Morbidly Obese Patients

  • Jordán González-Pérez
  • Sofía Sánchez-Leenheer
  • Alfredo Rivas Delgado
  • Lizbeth González-Vargas
  • Mariana Díaz-Zamudio
  • Gerardo Montejo
  • Sergio Criales
  • Nicholas Williams
  • Juan Pablo Pantoja
  • Mauricio Sierra
  • David Velázquez-Fernández
  • Miguel F. HerreraEmail author
Other

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a technically challenging surgical technique when features such as thick abdominal wall and increased liver volume are present. Very low calorie diets in the form of liquid meal replacements given 6 weeks prior to surgery have proven to decrease liver volume. The aim of our study was to assess the effect of a 6-week preoperative low calorie/regular diet on liver volume and body weight in morbidly obese patients.

Methods

A pilot study was carried out in 20 morbidly obese patients with an 800-kcal diet for 6 weeks. They were followed weekly to ensure proper compliance. CT scan was used for determining liver volume every 2 weeks in order to assess the impact of the diet. Baseline values were taken as controls for every patient as tied measures. Statistical analysis was suitable to variable scaling and performed using SPSS v. 20.0. Parametric and non-parametric test for tied measures were done. Any p value lesser than 0.05 or 5 % was considered as statistically significant.

Results

Twenty patients adhered to the diet intervention for 6 weeks prior to LRYGB. Median ± SD age was 34.5 ± 11.5 years and 17 were female (85 %). Heart rate and blood pressure did not vary across the study. Initial median ± SD BMI was 46.02 ± 5.29 kg/m2 (range 38.7–54.8). Repeated and tied measurements across the 6 weeks of treatment within individuals resulted statistically significant for reducing BMI (p < 0.0001). CT scan assessed liver volume initially as a control and in weeks 2, 4 and 6. Parametric and non-parametric assessment for multiple measurements also showed statistical significance among these values (p < 0.0001). Diet tolerability was additionally evaluated with a questionnaire showing more than 80 % of acceptability with discrete rates of nausea (15 %) and diarrhoea (15 %).

Conclusions

Based on our results, we demonstrated that a very low calorie diet with home ingredients is capable for effectively reducing body weight and liver size in morbidly obese patients. This relatively short intervention (4 to 6 weeks) was accomplished in all our patients with a high frequency of compliance and a low rate of secondary effects.

Keywords

Laparoscopic Roux-en-Y gastric bypass Low calorie diet Liver volume Body mass index 

Notes

Conflict of Interest

The authors of this manuscript declare no conflict of interest regarding any commercial label or pharmaceutical industry.

References

  1. 1.
    Hedley AA, Orden CL, Jonson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2004. JAMA. 2006;295(13):1549–55.CrossRefGoogle Scholar
  2. 2.
    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.PubMedCrossRefGoogle Scholar
  3. 3.
    Del Gaudio A, Boschi L, Del Gaudio GA, et al. Liver damage in obese patients. Obes Surg. 2002;12:802–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Moretto M, Kupski C, Mottin CC, et al. Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities. Obes Surg. 2003;13:622–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and lap-band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Podnos YD, Jiménez JC, Wilson SE, et al. Complications alter laparoscopic gastric bypass. Arch Surg. 2003;138:957–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Liu RC, Adheesh AS, Rorsyth C, et al. The effects of acute preoperative weight loss on laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1396–402.PubMedCrossRefGoogle Scholar
  10. 10.
    Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1282–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14:1165–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Lewis MC, Philips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.PubMedCrossRefGoogle Scholar
  13. 13.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.PubMedGoogle Scholar
  14. 14.
    Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass. Arch Surg. 2011;146(11):1300–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21:345–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Frutos MD, Morales MD, Luján J, et al. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17(2):150–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation. Transplantation. 2000;69(4):545–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Urata K, Matsunami H, Hashikura Y, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995;21:1317–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jordán González-Pérez
    • 1
  • Sofía Sánchez-Leenheer
    • 1
  • Alfredo Rivas Delgado
    • 1
  • Lizbeth González-Vargas
    • 2
  • Mariana Díaz-Zamudio
    • 3
  • Gerardo Montejo
    • 3
  • Sergio Criales
    • 3
  • Nicholas Williams
    • 1
  • Juan Pablo Pantoja
    • 1
  • Mauricio Sierra
    • 1
  • David Velázquez-Fernández
    • 1
  • Miguel F. Herrera
    • 1
    Email author
  1. 1.Department of SurgeryInstituto Nacional de la Nutrición Salvador ZubiránMexico CityMexico
  2. 2.Clinic for ObesityInstituto Nacional de la Nutrición Salvador ZubiránMexico CityMexico
  3. 3.Department of RadiologyInstituto Nacional de la Nutrición Salvador ZubiránMexico CityMexico

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